OncologyTier 2Disease (DEADMAN)

Cancer - mouth

Description

Squamous cell carcinoma of the oral cavity (tongue, floor of mouth, buccal mucosa, gingiva, hard palate) - part of the head and neck cancer spectrum

Strongly associated with smoking, alcohol, and betel nut/areca chewing (particularly relevant in South and Southeast Asian populations); rising incidence of HPV-associated oropharyngeal (not oral cavity) cancer in some populations, typically younger, non-smoking patients

Same field cancerisation mechanism as other upper aerodigestive tract squamous cancers - sequential mucosal dysplasia progressing to invasive carcinoma under chronic carcinogen exposure
Oral potentially malignant disorders (leukoplakia, erythroplakia, oral lichen planus) are recognised precursor lesions with a defined (if variable) malignant transformation risk

A non-healing oral ulcer persisting beyond 2-3 weeks in an at-risk patient warrants biopsy - the single most important clinical trigger for early diagnosis
Examination includes bimanual palpation of the floor of mouth/tongue (depth of invasion is a key prognostic factor, better assessed by palpation than visual inspection alone) and neck examination for nodal disease
MRI for local extent/depth of invasion; CT/PET for nodal and distant staging

Surgical resection is the mainstay for oral cavity cancer (in contrast to laryngeal/oropharyngeal cancer, which can often be radiotherapy-led) - reconstructive surgery (flaps) often required for functional/cosmetic outcomes
Adjuvant radiotherapy +/- chemotherapy for high-risk features (positive margins, extranodal extension, perineural/lymphovascular invasion)
Depth of invasion is a key factor determining whether elective neck dissection is needed even in a clinically node-negative neck

Smoking, alcohol, betel nut chewing, oral potentially malignant disorders (leukoplakia, erythroplakia), HPV (oropharyngeal, not oral cavity, subsite)

Early-stage disease has good surgical cure rates; delayed diagnosis (common, given non-specific early symptoms) is associated with substantially worse outcomes - underscoring the value of routine oral examination and a low threshold for biopsying a non-healing ulcer

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